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CusrourR I usrRuc-noN FoRM r\L^-!^*^"J { r ,''}
Branch Seai VI JU! L\/l *U ..i'];:;.Nk

Dere: ........../...... ..."...1.......

UNT TITLE

L-j Request for Balance Confirmation Certificate. Balance should be mentionecj in .

il BDT I cgp I usn D others


L-..I Request for Bank Cedifrcate:
related
il Account related
n Tax reiated
I Requert for.Account Statement (Fronn .1........t........ To... .,...1.....,....t...........)
fl Request to Hold Statement Reason :

[i Cther lnstr-uctrons

i unclerstand that fees and VAT will be deducted from my/ our account for this purpose as per Schedule of
Charges,

Authorized person must bring an authoi-lzation lettervyhere his/ her signature is attested by the accounthcider-(s).

Cusror'rrr R(s )' S roniniu Rr

Nanre: Name:
(in biock letter) (in block letter)

Barux Use Oulv Recrrvro ev SrcNRruRr

SI ruRe Venrpteo

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